How is Physical Activity Measured in Spinal Muscular Atrophy and Duchenne Muscular Dystrophy?

BACKGROUND

Physical activity (PA) provides many substantial benefits to help reduce risk for cardiometabolic disease, improve cognitive function, and improve quality of life. Individuals with neuromuscular disorders (NMDs), such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD) are characterized by muscular weakness and fatigue, which limits the capacity to reach the recommended guidelines of PA. Measuring PA in these populations can provide insight to participation in daily activities, track disease progression, and monitor efficacy of drug treatments.

OBJECTIVE

The objective of this study was to identify how PA is measured in SMA and DMD using instrumented and self-report methods, and how these methods are employed in ambulatory and non-ambulatory groups.

METHODS

A scoping review was performed to identify studies that reported PA in these neuromuscular disorders. Inclusion was determined after a multi-stage review process by several reviewers, followed by an in-depth analysis of metrics reported by each tool that was used.

RESULTS

A total of nineteen studies were identified and included in this review. Sixteen studies included instrumented measures and four studies utilized self-reported measures, with eleven studies also reporting PA information from a non-ambulatory group. A variety of metrics have been reported using both classes of measurement tools.

CONCLUSION

Although a wide variety of research exists that details both instrumented and self-reported measurement tools, feasibility, cost, and study aims are important factors to consider in addition to testing methodology when selecting which type of tool to use. We recommend using a combination of instrumented and self-report measures to provide context to the PA measured in these populations. Improvements in both instrumented and self-report methodologies will add valuable knowledge about the disease burden and efficacy of treatment and disease management methods in SMA and DMD.

Effects of two exercise programs on health-related fitness, quality of life and exercise enjoyment in adults with visual impairment: a randomized crossover trial

BACKGROUND

So far there is no study comparing two distinct exercise interventions in people with visual impairment. This study aimed to evaluate the effects of two exercise programs on health-related fitness, quality of life, and exercise enjoyment in people with visual impairment.

METHODS

Two exercise interventions were conducted: sports (i.e., Goalball, Football 5-a-side and Martial Arts) and functional training (i.e., Bodyweight exercises). Physical fitness was assessed by handgrip strength, flexibility, abdominal endurance, and cardiorespiratory fitness. The Physical Activity Enjoyment Scale (PACES) measured the pleasure in the practice of physical exercises, and the quality of life was measured by the WHOQOL-Bref.

RESULTS

A significant time x group interaction terms were observed for flexibility (P < 0.001; Cohen d = 0.08), abdominal muscular endurance (P < 0.001; Cohen d = 0.15), and distance covered in the 6-min walk/run test (P = 0.018; Cohen d = 0.02). An improvement of 13.3% and 5.1% on the distance covered on the 6-min walk/run test after sports and functional training was also observed.

CONCLUSION

The functional training program was reported as more pleasant for participants. Sports-related exercises and functional training improved health-related fitness and quality of life for people with visual impairment.

Physical activity recommendation by health care providers to adults with and without functional limitations

Adults with functional limitations are more likely to be physically inactive than those without functional limitations, despite evidence that regular physical activity (PA) slows the progression of functional decline. The health care setting provides an opportunity to communicate with patients about positive behavior changes, including increased PA, but there is little information about provider recommendation for PA to adults with functional limitations. This study investigated health care provider recommendation to increase PA among adults with and without functional limitations. Adults (≥18 years) who participated in the 2016 National Health Interview Survey and reported ≥1 primary care encounter within the previous 12 months were included (unweighted n = 23,540; weighted N = 170,004,764). Receipt of PA recommendation and physical functioning limitations were self-reported. Statistical analyses were weighted to account for complex survey sampling design. One-third (35.88%) of adults received a PA recommendation and 19.71% reported functional limitations. Adults who received a PA recommendation were more likely to have a functional limitation than those who did not (28.64% vs. 14.70%; p < 0.001), even after adjusting for covariates and current activity level (aOR = 1.48; 95% CI:1.33,1.65). PA recommendation for those with functional limitations appeared to increase during middle age and peak for adults aged 65-75 years (57.01%) but declined substantially for adults ≥75 years. Only one-third of adults in the United States received PA recommendations. Health care providers recommended PA to approximately half of adults with functional limitations. Continued efforts to leverage health care encounters for behavior change should be explored, particularly for middle aged and older adults.

Factors Associated With the Intention to Begin Physical Activity Among Inactive Middle-Aged and Older Adults

Factors that affect physical activity (PA) behavior change are well established. Behavioral intention is a strong psychological predictor of behavior; however, there is less research on the factors that affect the intention to increase PA participation specifically, especially among adults in mid and later life who are inactive. Using data from the Canadian Community Health Survey, which was informed by the transtheoretical model (TTM), this study investigated the relationships between a range of demographic and biopsychosocial factors with the intention to become physically active among 1,159 inactive adults aged 40 years and older. Comparisons were made between participants reporting the intention to begin PA in the next 30 days (TTM Preparation; n = 610), 6 months (TTM Contemplation; n = 216), or not at all (TTM Precontemplation; n = 333). First, multinomial logistic regression identified age, sex, ethnicity, education, restriction of activities, self-perceived health, and community belonging as factors significantly associated with 30-day PA intention, while age and ethnicity were significantly associated with 6-month PA intention, compared with those reporting no intention. Second, binary logistic regression revealed that education was the only factor that differentially associated with intention timeframe as participants with lower levels of education were less likely to report PA intention in 30 days compared with 6 months. Findings demonstrate key demographic, biopsychosocial, and temporal factors that warrant consideration for tailored PA promotion programs that aim to effectively address the constraints and barriers that negatively influence PA intention among middle-aged and older adults.

Assessment of muscle-strengthening exercise in public health surveillance for adults: A systematic review

There is strong scientific evidence that muscle-strengthening exercise (i.e. use of weight machines, push-ups, sit-ups) is independently associated with a reduced risk of multiple chronic diseases (e.g. diabetes, hypertension, cardiovascular disease). However, prevalence rates for meeting the muscle-strengthening exercise guideline (≥2 times/week) are significantly lower (~20%) than those reported to meet the aerobic physical activity guideline (e.g. walking, jogging, cycling) (~50%). It is therefore important to understand public health surveillance approaches to assess muscle-strengthening exercise. The aim of this review was to describe muscle-strengthening exercise assessment in public health surveillance. Informed by the PRISMA guidelines, an extensive keyword search was undertaken across 7 electronic data bases. We identified 86,672 possible articles and following screening (n = 1140 in full-text) against specific inclusion criteria (adults aged ≥18 years, English, studies containing <1000 participants), extracted data from 156 manuscripts. Fifty-eight different survey systems were identified across 17 countries. Muscle-strengthening exercise frequency (85.3%), duration (23.7%) and intensity (1.3%) were recorded. Muscle-strengthening exercise questions varied significantly, with some (11.5%) requiring a singular 'yes' vs 'no' response, while others (7.7%) sought specific details (e.g. muscle groups targeted). Assessments of duration and intensity were inconsistent. Very few studies measured the validity (0.6%) and reliability (1.3%) of muscle-strengthening exercise questions. Discrepancy exists within the current assessment systems/surveys used to assess muscle-strengthening exercise in public health surveillance. This is likely to impede efforts to identify at risk groups and trends within physical activity surveillance, and to accurately assess associations between muscle-strengthening exercise and health-related outcomes.